Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mia R Dericco

Individual provider Medical Physician Assistant · NPI 1194407999

Mia R Dericco is a Physician Assistant in Bay Shore, New York. Qualified in 2023, 3 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023
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Practice location Address checks out

270 E Main St
Bay Shore, NY 11706-8420
Phone: (631) 591-7470
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 030197 (NY)

Record details

NPI number1194407999
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 2, 2023
Last updated in NPPESAugust 2, 2023
Certification dateJuly 14, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Bay Shore